Experimental Setup Employed in the Operating Room Based on Virtual and Mixed Reality: Analysis of Pros and Cons in Open Abdomen Surgery

Abstract

Currently, surgeons in operating rooms are forced to focus their attention both on the patient’s body and on flat low-quality surgical monitors, in order to get all the information needed to successfully complete surgeries. The way the data are displayed leads to disturbances of the surgeon’s visuals, which may affect his performances, besides the fact that other members of the surgical team do not have proper visual tools able to aid him. The idea underlying this paper is to exploit mixed reality to support surgeons during surgical procedures. In particular, the proposed experimental setup, employed in the operating room, is based on an architecture that put together the Microsoft HoloLens, a Digital Imaging and Communications in Medicine (DICOM) player and a mixed reality visualization tool (i.e., Spectator View) developed by using the Mixed Reality Toolkit in Unity with Windows 10 SDK. The suggested approach enables visual information on the patient’s body as well as information on the results of medical screenings to be visualized on the surgeon’s headsets. Additionally, the architecture enables any data and details to be shared by the team members or by external users during surgical operations. The paper analyses in detail advantages and drawbacks that the surgeons have found when they wore the Microsoft HoloLens headset during all the ten open abdomen surgeries conducted at the IRCCS Hospital “Giovanni Paolo II” in the city of Bari (Italy). A survey based on Likert scale demonstrates how the use of the suggested tools can increase the execution speed by allowing multitasking procedures, i.e., by checking medical images at high resolution without leaving the operating table and the patient. On the other hand, the survey also reveals an increase in the physical stress and reduced comfort due to the weight of the Microsoft HoloLens device, along with drawbacks due to the battery autonomy. Additionally, the survey seems to encourage the use of DICOM Viewer and Spectator View both for surgical education and for improving surgery outcomes. Note that the real use of the conceived platform in the operating room represents a remarkable feature of this paper, since most if not all the studies conducted so far in literature exploit mixed reality only in simulated environments and not in real operating rooms. In conclusion, the study clearly highlights that, despite the challenges required in the forthcoming years to improve the current technology, mixed reality represents a promising technique that will soon enter the operating rooms to support surgeons during surgical procedures in many hospitals across the world.

Effects of Sevoflurane versus Propofol on Endogenous Nitric Oxide Metabolism during Laparoscopic Surgery

“…(2) e difference of hemoglobin before and after operation: laparoscopic group: 8.97 ± 7.52 (g/L) and open group: 13.06 ± 11.07 (g/L) (P � 0.044). (3) e average number of pelvic lymph nodes removed in the laparoscopic group was 21.83 ± 11.93, and that in the laparotomy group was 19.16 ± 10.24 (P � 0.391). e average number of para-aortic lymph nodes removed in the laparoscopic group was 3.66 ± 2.23, and that in the open group was 2.66 ± 1.73 (P � 0.387).…”

“…In recent years, a large number of foreign scholars have made excellent research on the effect of sevoflurane compared with propofol on endogenous nitric oxide metabolism in laparoscopic surgery. Bagia et al used a large number of experimental research methods in its research, compared different patients in the experimental group and the control group using sevoflurane and propofol, and concluded that the use of this drug in laparoscopic surgery can greatly reduce the side effects of patients and improve the therapeutic effect [2,3]. Chambers et al used case comparison method to compare the drug use of different groups of patients in different course of disease.…”

Application of Mixed Reality in Medical Training and Surgical Planning Focused on Minimally Invasive Surgery

“…The mental and physical workload of users with regard to the use of these applications could be determined using a NASA-TLX (Task Load Index) questionnaire (Turini et al, 2018). Similarly, the ultimate system usability or user's interest/ enjoyment could be analyzed by means of the System Usability Scale (SUS) (Gregory et al, 2018) or the Intrinsic Motivation Inventory (IMI) scale (Galati et al, 2020), respectively.…”

“…The applications were developed using the Mixed Reality Toolkit development kit for Unity, which has become the standard for developing any MR application with HoloLens devices. This has been used in many medical applications for rhinoplasty (Maasthi et al, 2020), arthroplasty training (Turini et al, 2018), and open abdominal surgery (Galati et al, 2020). Loading of preoperative imaging studies with Digital Imaging and Communication on Medicine (DICOM) format was performed using a customised version of the Fellow Oak DICOM toolkit (Al-Zu'bi et al, 2017).…”

Remote mentoring in laparotomic and laparoscopic cancer surgery during Covid-19 pandemic: an experimental setup based on mixed reality

“…By exploiting our expertise in smartglasses-based open abdomen surgeries [ 7 ], we have used MR in the operating rooms for remote mentoring of the medical staff under training during Covid-19 pandemic. The study evaluates the implementation of MR in the cancer surgeries carried out at the IRCCS Hospital ‘Giovanni Paolo II’ in the city of Bari (Italy).…”